The drama had built for months, pitting a group of Democrats against the Catholic Church. Priests and bishops were calling members to lobby for stricter language to limit abortion coverage, members and aides said last week.

But the final decision played out over a few furious hours Friday night as the fate of the broader bill still hung in the balance and stirred up long-dormant tensions within the Democratic Party over reproductive rights.

The beneficiary of this impasse was Stupak, an outspoken abortion-rights opponent whom the leadership had tried to circumvent, in order to pick up the votes he claimed to represent. After months of stalemate, the speaker was forced to accept language Stupak first drafted over the summer that would bar any insurance company that participates in the exchange — including the government option — from offering insurance plans that would cover abortions.

“Normally, at the end of the day, you’re arguing over fine-tuning,” said an aide whose boss was involved in the negotiations. “But this is a sizable change to current policy. So everyone was kind of stunned.”

For more than a decade, the Hyde amendment has prohibited the federal government from paying for abortions through any existing government program. The law needs to be reauthorized each year as part of the appropriations process, but the two sides had come to something of a détente.

The health care fight, however, disrupted that balance, and a big bloc of anti-abortion Democrats were threatening to derail the entire bill unless party leaders agreed to stronger restrictions the church could accept. Since mid-September, House Majority Leader Steny Hoyer had been working closely with Rep. Brad Ellsworth (D-Ind.) to craft language that would thread what proved to be an impossible needle.

Ellsworth, in consultation with the U.S. Conference of Catholic Bishops, was trying to amend legislation passed out of the Energy and Commerce Committee to make sure insurance companies that receive federal funds under the programs created by the bill don’t use any of that money to pay for abortions.

By Thursday, Ellsworth, who was working closely with Rep. Mike Doyle (D-Pa.) realized the church wouldn’t accept anything less than a version of Hyde, so he and his staff started working on a version the bishops could accept, aides said.

Ellsworth reached out to Stupak on Thursday, and Friday evening they met with Pelosi, Hoyer and Rep. Henry Waxman, at which point the group agreed to include much stricter language than most thought they would.

But they realized they would need Republican votes to approve the rule — and win the support of the church and, in turn, wavering Democrats — meaning they needed to go much further than anyone anticipated to bring an avowed Democratic opponent, National Right to Life, on board, aides involved said afterward.

Pelosi met with members of the Pro-Choice Caucus repeatedly that day, and finally, during the contentious three-hour session that resulted in the DeLauro-Miller shouting match, Pelosi broke the bad news to abortion-rights supporters — she was going to allow a vote on the Stupak amendment.

Multiple sources said Pelosi’s decision angered DeLauro and other Democrats who support abortion rights, like Reps. Diana DeGette of Colorado, Louise Slaughter of New York and Lois Capps of California. Slaughter even boycotted her own Rules Committee while it debated the amendment.

“He moved the goal posts, and he said if he didn’t get his amendment made in order, he would vote against the bill,” DeGette said of Stupak. “The speaker concluded that she needed the votes.”

“I don’t believe any of us believe we can hold up what we’ve been fighting for ... and that’s health care,” Slaughter said before the vote.

The bishops objected to the segregated funds proposal previously embraced by the House and Senate Democratic leaders in part because they argued that it amounted to nothing more than an accounting gimmick.

They should know. After all, how many American dioceses have filed bankruptcy to avoid paying out damages in child molestation suits?

“We think that providing health care is itself a pro-life thing, and we think that, by and large, providing better health coverage to women could reduce abortions,” said Richard M. Doerflinger, a spokesman for the anti-abortion division of the United States Conference of Catholic Bishops.

“But we don’t make these decisions statistically, and to get to that good we cannot do something seriously evil.”

No, no, not at all. For example, the Church wouldn't dream of something like making minor coughing noises about an unjust war, yet remarkably taking no action to stop it. Is that what you mean, Mr. Doerflinger?

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